With a growing number of childless adults in the United States not expecting to ever have children, Los Angeles’s Cedars-Sinai hospital is respecting the bodily choices of people with uteruses by offering surgical permanent contraception, or tubal ligation.
A Pew Research Center study shows that 44% of non-parents aged 18 to 49 years say it is not too likely, or not likely at all, that they will ever have children, which is a 7% increase from those who said the same in a 2018 survey. The study also shows that 74% of adults who are younger than 50 and already parents say they are unlikely to have more children.
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According to the Pew study, reasons for not wanting children include financial, medical, and environmental (such as climate change) reasons, age, and not having a partner. But the majority (56%) of non-parents younger than 50 years say they simply do not want to have children.
“We are experiencing a significant increase in requests for consultations about the option of permanent contraception from women who want to remain child-free. They are expressing serious concern about their ability to have control over their reproductive health,” said Dr. Natasha Schimmoeller, surgical gynecologist at Cedars-Sinai Family Planning Program.
When the US Supreme Court overturned the landmark Roe v. Wade decision last summer, which guarantees individual rights to abortions, California brought forth legislation to protect in-state providers and out-of-state patients. To continue work towards protecting reproductive rights, the state issued funds on January 5th to increase the number of providers offering reproductive healthcare services.
One of Schimmoeller’s areas of expertise is tubal ligation, which is the surgical removal of fallopian tubes to prevent pregnancy, and has long been offered immediately after childbirth to people who don’t plan to have more children. The procedure is historically less available for women who intend to never become pregnant.
“Most OB-GYNS don’t do these surgeries because they worry about the risk of regret,” Schimmoeller said. “This is the only field in all of medicine where regret is so emphasized—it’s very gendered.”
When tubal ligation is not performed immediately after someone has given birth, it’s a 30-minute laparoscopic surgery, where two small incisions (as small as three millimeters) are made on either side of the abdomen near the hips, and one inside of the belly button in order to remove the fallopian tubes.
Removing fallopian tubes eliminates the bridge for the sperm to reach the ovaries. Unlike hysterectomies, which is the removal of the uterus, tubal ligations do not touch the uterus or ovaries. As a result, individuals will still menstruate and their hormones will remain the same. Many who undergo the surgery take over-the-counter pain medication for several days, and return to normal activities and work in a week.
“For our team, offering permanent contraception to anyone who seeks it is [a] principle-based practice of medicine,” Schimmoeller said. “I can give objective scientific data in my role as a doctor and surgeon, but the ultimate sign of respect is that I believe that you know your life the best.”
Cedars-Sinai is one of the only facilities in the country that prioritizes this procedure for individuals who never want to have children. Appropriate candidates include anyone who is certain they do not want to have children. Medicaid requires individuals to be at least 21 years, while private insurance requires people to be at least 18 years old. About 25% of Schimmoeller’s patients identify as transgender or nonbinary.
“If people change their mind, they can still do in vitro fertilization to try to get pregnant. This field—women’s reproductive health—is the only one of all medicine in which the possibility of future regret is so heavily emphasized,” Schimmoeller said.
The American College of Obstetricians and Gynecologists suggests physicians should counsel those seeking tubal ligation about the permanence of the procedure, but moreso, should respect the individual’s right to make decisions about their bodies when they’re confident that it will benefit them.